Health plans - consumer-driven

[Guidance Overview] CRS Report: Introduced or Enacted Bills to Repeal, Defund, Delay or Amend the ACA (PDF)25 pages. "This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the ACA since it was enacted.... Table 1 summarizes the ACA changes that have been signed into law. Table 2 lists all the House-passed ACA bills. Table 3 summarizes the ACA provisions in the vetoed reconciliation bill.... This report is updated periodically to reflect legislative and other developments." [Report R43289, Nov. 10, 2016] (Congressional Research Service [CRS])

Controversial Narrow Networks May Help Lower Healthcare Costs"With the health insurance industry shifting toward a more consumer-centric mindset, providing shoppers with choices is imperative so they can make informed decisions about their care. And while narrow networks may impede consumer choice, they could also provide benefits[.]" (FierceHealthPayer)

[Official Guidance] Text of IRS Revenue Procedure 2015-30: 2016 Inflation-Adjusted Amounts for Health Savings Accounts (HSAs) (PDF)"[1] Annual contribution limitation: For calendar year 2016, the annual limitation on deductions under Section 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $3,350. For calendar year 2016, the annual limitation on deductions under Section 223(b)(2)(B) for an individual with family coverage under a high deductible health plan is $6,750. [2] High deductible health plan: For calendar year 2016, a 'high deductible health plan' is defined under Section 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,550 for self-only coverage or $13,100 for family coverage." (Internal Revenue Service [IRS])

Account-Based Health Plan Adoption on the Rise"In 2014, nearly three-quarters of employers offered their employees one or more account-based health plans (ABHPs). Another 9 percent expected to add an ABHP to their plan options for the plan year 2015. In addition, 16 percent of employers now offer ABHPs as the only plan option, more than double the rate in 2012. No other plan types saw such positive growth in 2014.... An ABHP is an employer-sponsored health plan that combines a high deductible with either a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA) -- tax-advantaged accounts that employees can use to pay eligible health care expenses." (OneExchange from Towers Watson)

Lowering Deductibles Through Workouts"By incenting employees to work out, Pact Health serves as a type of Health Reimbursement Arrangement vehicle that allows employees to lower their health deductibles with each workout.... For example, if a group increased their deductible to $2,000, Pact Health would reimburse employees for the first $1,000 of deductible expenses, so the plan essentially mirrors a $1,000 deductible plan. Then, for every time an employee completes a workout towards their 'pact', they could have the opportunity to exercise their way down to a $500 deductible. Conversely, if they miss their workouts, their deductible could grow to $1,500." (William Gallagher Associates)

Recommendations to Achieve a More Transparent Health Care System for Consumers (PDF)"Especially in the current health care environment, where consumers are taking on more of the cost burden through increasing out-of-pocket costs, particularly from the growth of high deductible health plans, they need and want more information.... If the goal is to change the priority from increasing volume of data to providing more practical and meaningful [information], attention to regulatory reforms is critical." (The Brookings Institution)

Private Exchanges Decrease Employer Costs, Change Employee Enrollment Behavior"While only 38 percent of employees in general are aware of what employers pay for health benefits on their behalf, 94 percent of employees using [Glidepath, a private health insurance exchange sponsored by Blue Cross Blue Shield of Michigan,] were aware of their employer's benefit contribution.... Employees had a greater tendency to choose plans with lower premiums and higher deductibles.... Employers using Glidepath set a defined contribution amount and their employees use those funds to actively shop online to select a health plan using the exchange." (InsuranceNewsNet.com)

What Every Family Should Know About High Deductible Health Insurance"The average deductible for single coverage under employer plans this year is $1,217. That's almost double what it was in 2006. The trend is not going to abate. Next year 4 in 5 large employers will offer a high deductible plan and 1 in 3 will offer only a high deductible plan. Moreover, the deductibles in the plans offered on the (Obamacare) health insurance exchanges are more than twice as high as the average employer plan. High deductibles are not necessarily a bad thing. They may be a good thing. Here are ten things you should know in planning for your own health insurance needs." (John Goodman, in Forbes)

Guess Who's Moving to Consumer-Driven Health Plans: Doctors' Offices"'The [American Medical Group] survey revealed that HDHPs along with CDHPs made up more than 1/3 of health plans analyzed and were as prevalent as PPOs. These plan types dwarfed HMOs, which made up only about 10% of analyzed plans.' ... The use of the verb 'dwarfed' to describe the tiny share of HMO coverage is interesting. Physicians and their staff -- by their behavior -- are telling us that they trust themselves as consumers to keep health costs down and quality up better than they trust themselves as bureaucrats in a top-down system." (National Center for Policy Analysis Health Policy Blog)

Consumer-Driven Plans Are Driving Increase in Health Management"CDHP plan enrollees were nearly 50 percent more likely to complete a health risk assessment, and those with a chronic illness were up to 41 percent more likely to participate in a disease management program, than enrollees in traditional plans.... Participants in HSA plans were more likely than those in traditional plans to choose generic medications. In addition, CDHP enrollees used the emergency room at a 5 percent lower rate than enrollees in HMO and PPO plans." (Society for Human Resource Management [SHRM])

Consumer-Driven Health Plans Help Employees 'Own' Their Healthcare"Cigna CDHP customers were nearly 50 percent more likely to complete a health risk assessment, and those with a chronic illness were up to 41 percent more likely to participate in a disease management program than those enrolled in a traditional plan.... Cigna CDHP medical cost trend was 12 percent lower than traditional plans during the first year. Cumulative savings over 5 years of $7,900 per employee can be achieved. Cost reductions were achieved without employers shifting out-of-pocket health expenses to their employees." (Healthcare Trends Institute)

Characteristics of the Population with Consumer Driven and High Deductible Health Plans, 2005-2013"The population of adults within consumer-driven (CDHPs), high-deductible (HDHP) and traditional health plans was split about 50-50 between men and women in 2013. The CDHP population was more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2006, 2009 and 2010. They were also more likely to be in households with $100,000-$149,999 in income in most years. CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have college or post-graduate educations in nearly all years of the survey." (Employee Benefit Research Institute [EBRI])

Health Insurance Information Frictions, Plan Choice, and Consumer Welfare"[C]onsumers lack information on many important dimensions that they are typically assumed to understand, perceive high plan hassle costs, and make choices that depend on these frictions.... [I]ncorporating measures of these frictions leads to meaningful reductions in estimated consumer risk aversion.... [The authors] assess the welfare impact of a counterfactual menu design and find that the welfare loss from risk exposure when additional frictions are not taken into account is more than double that when they are[.]" (National Bureau of Economic Research [NBER])

Caps on Payments for Specific Healthcare Procedures Help Employers Cut Costs"As companies seek ways to curb health-care spending, insurer WellPoint Inc. is rolling out a program that lets employers pay only a set amount for a medical service, asking workers who select costlier care to pay the difference.... [B]roader availability of the per-procedure pricing setups, if they work smoothly, may spark more widespread adoption by employers. A survey of large and midsize employers ... found that 8% were using the approach. However, nearly two-thirds were considering the model for the future." (The Wall Street Journal; subscription may be required)

With High Deductible Health Plans, It Pays To Shop Around For Care"Proponents of high-deductible plans say consumers will make more cost-conscious health care choices if they have to spend more of their own money. According to [one] analysis ... consumers in such plans cut their medical spending by between 5 and 14 percent. But results were mixed on whether they cut back only on unnecessary care or on treatment that was needed." (Kaiser Health News)

More Than Half of Population Not Wedded to a Particular Doctor"[W]hile a substantial minority of the population will in fact want to be certain that their physician participates in a health plan before selecting that plan, a surprising majority considers this an open question. Nearly twenty-four percent of the respondents report that they do not have a regular doctor, while an additional thirty-four percent would switch in order to receive premium savings. Over half of the latter group would do so for the lowest savings amount presented by the survey, $500 to $1,000 annually." (HealthPocket)

Survey Results: American Workers on Uphill Road with Consumer-Driven Health Care (PDF)"Nearly three-quarters (72 percent) of the workforce have not heard of the phrase 'consumer-driven health care'; More than half (54 percent) of workers would prefer not to have greater control over their insurance options because they don't have the time or knowledge to effectively manage it; 62 percent of workers believe the medical costs they will be responsible for will increase, while only 23 percent are saving money for potential increases; 75 percent of workers said they think their employer would educate them about changes to their health care coverage as a result of reform, but only 13 percent of employers said educating employees about health care reform was important to their organization." (Aflac)

[Opinion] The Myth of the Smarter Healthcare Consumer"[T]he notion that access to prices alone will enable consumers to choose suitable coverage makes two big assumptions about consumers: (1) that they are in a position to accurately identify and predict their healthcare needs; and (2) that they won�t be inclined to value the short term (i.e., more money in their pocket each month due to lower health insurance premiums for higher deductible plans) over the long term (i.e., access to health care treatment they can actually afford when they most need it). The stark reality is that both of these assumptions are wrong." (The Health Care Blog)

Empowering Individuals to Be Better Health Care Consumers"Today, [consumer-directed healthcare] is one important part of the consumer equation, but evolving market forces, including the blurring of lines between payers and providers (e.g., payers vertically integrating with providers; and providers taking on risk and becoming more like payers), are further complicating the landscape by redefining who the consumer engages with as he or she navigates the healthcare system." (Triple Tree; free registration required to download full report)

Survey Finds Continued Slow Growth in Consumer-Driven Health Plans"[T]he most important take away by far is that people are doing exactly what we predicted they would do. They are paying more attention to the cost of the services they consume on every one of nine measures. For example, 53% of CDHP enrollees requested a generic drug instead of a name-brand, while only 41% of traditional plan enrollees did." (John Goodman's Health Policy Blog)

2012 Deloitte Survey of Health Care Consumerism"Conducted annually since 2008, Deloitte�s longitudinal study of heath care consumers seeks to provide a comprehensive view of health care consumerism, a view that goes beyond the conventional boundaries of what health and health care are commonly thought to encompass.... This report provides data-driven insights gleaned from the Deloitte 2012 Survey of U.S. Health Care Consumers as well as a look back at five years of findings that point to untapped potential for increased health care industry engagement with consumers and, with that, new challenges and opportunities for providers, health plans, employers, and government." (Deloitte)

Who Knew? Patients' Share of Health Spending Is Shrinking"Consumer-driven medical spending may be the second-biggest story in health care, after the [ACA]. As employers give workers more 'skin in the game' through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending. ... Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades." (Kaiser Health News)

Consumer Discretionary Health Care Spending: Analysis of Direct and Indirect Out-Of-Pocket Costs to Consumers"In 2010, total U.S. health-related expenditures were an estimated $3.2 trillion or 23.9 percent higher than reported in the National Health Expenditure Accounts (NHEA). This translates to $10,392 per person. An additional $621 billion in direct and indirect costs was estimated for goods and services above what is captured in NHEA accounting. Of this additional amount, $492 billion (79 percent) is the imputed value of unpaid supervisory care given to individuals by family or friends." (Deloitte Center for Health Solutions)

Consumers May Draw Wrong Conclusions from Medical Prices"[A] new study ... suggests that consumers' perceptions of prices could lead them to the wrong conclusions. At a low price, something like a flu shot signals 'great communal benefit -- an item that is accessible because people need it to be healthy,' the authors said. 'Conversely, high prices signal reduced accessibility and hence less need.' That kind of thinking can lead to bad, possibly dangerous, health decisions if consumers decide there's less risk in foregoing higher-priced health products and services." (Kaiser Health News)

[Opinion] Obamacare Threatens Health Care Cost Containment"Employers' health benefit cost growth had the smallest increase in 15 years -- only 4.1 percent in 2012 compared to 6.1 percent in 2011 ... The lower-than-usual increase in costs is attributed, in part, to increased usage of consumer-directed health plans (CDHP).... It will be difficult for CDHPs to meet the MLR requirement, because they have lower premiums, which reduces their total revenue.... Obamacare's hindrance of these plans comes in the face of their growing popularity and cost containment." (The Heritage Foundation)

Recent Studies Address Consumer-Directed Health PlansIncludes summary and links to various studies, including a Blue Cross Blue Shield survey, a survey of employers in Michigan, a study by the Robert Wood Johnson Foundation, and an op-ed article about Indiana's HSA program. (John Goodman's Health Policy Blog)

Employers Cautious Toward Exchanges, Embrace CDHPs"In preparation for the 40 percent excise tax on high cost 'Cadillac' plans scheduled to take effect in 2018, 31 percent of employers indicated that they plan to reduce their benefits in 2014-2016, with 41 percent responding they will do so for 2017-2018. For the next few years, there is little indication that employers plan to drop health care coverage and give employees money to buy health care coverage elsewhere. Only 9 percent of employers indicated that they planned to participate in state health insurance exchanges when they begin in 2014-2016." (Society for Human Resource Management)

Open Enrollment Tips for Employees"[B]enefits offered to employees next year may be impacted by a number of factors, including rising health care costs, the declining health of the population, and phase-in of provisions under the [ACA].... 55 percent of employees default to their current benefit coverage for the coming year, instead of actively reassessing their plan options. Employers should remind workers that the old selection may not be the best option." (Wolters Kluwer Law & Business)

Turning Consumers Into Shoppers: Using High-Deductible Plans Wisely"[A recent] analysis found that during the first year following enrollment, members of HDHPs had fewer hospitalizations than patients enrolled in traditional plans. They also had fewer episodes of care, fewer visits to specialists, and lower use of brand-name drugs -- all of which reduced overall costs. However, there also was one troubling finding: Those in HDHPs cut back on preventive services along with other services." (Health Affairs Blog)

Consumer-Driven Health Plans Overtake HMOs"[M]ore than a quarter of companies say they may take a defined-contribution approach to healthcare within the next few years by giving employees a set amount of money to buy insurance on a private healthcare exchange. Fifty-eight percent of the companies [recently] surveyed ... offered some type of consumer-driven health plan (CDHP) last year, up from 41% the previous year, while just 38% offered an HMO, down from 41%. Preferred provider organizations (PPOs) are still more common than either CDHPs or HMOS and were offered by 79% of employers." (Treasury & Risk)

Choosing Health Insurance Tougher Than Parenting Decisions"Why are people so intimidated? ... 88 percent of those interviewed said the available information is confusing and complicated. 84 percent complained that health plans provide conflicting details. 83 percent said that, in the end, it can be too hard determining which plan is best for them." (FoxBusiness.com)

[Opinion] Comments on Move by Large Self-Insured Employers to Defined Contribution Health Plans"It is likely that the initial defined contributions will be fairly close to the amounts that employers are currently paying for the health benefit programs, so the immediate impact will not be transparent. Only after many employees face bankrupting medical debt --- a phenomenon that will increase as the employer contribution buys ever less insurance - will the implications be clear. It is tragic ..." (Physicians for a National Health Program)

CDHPs Second Most Common Plan Design Offered By Employers"Consumer-driven health plans (CDHPs) have surpassed health maintenance organizations (HMOs) to become the second most common plan design offered by U.S. employers ... [I]in 2011, 58 percent of employers offered a CDHP and 38 percent offered an HMO. Preferred provider organizations (PPOs) continue to be the most widely offered plans, with 79 percent of employers offering these plans in 2011." (Wolters Kluwer Law & Business)

Is Consumer-Directed Coverage a Healthy Choice?"According to [a recent] survey ... [low-premium, high-deductible] plans were offered by 58% of employers in 2011, up from 41% in 2010. Separately, 19% of large employers [in a second survey] said consumer-directed plans would be the only option they offered for 2013.... For healthy people who are able to manage their expenses, consumer-directed plans can result in real savings. But those with chronic diseases or with a serious risk of injury face the prospect of much higher out-of-pocket costs." (MarketWatch.com)

Prevalence of Consumer-Driven Health Plans Is Growing"Consumer-driven health plans (CDHPs) have surpassed health maintenance organizations (HMOs) to become the second most common plan design offered by U.S. employers ... [A recent] survey of nearly 2,000 U.S. employers representing over 20 million U.S. employees and their dependents found in 2011 that 58 percent of employers offered a CDHP and 38 percent offered HMO plans. Preferred provider organizations (PPOs) continue to be the most widely offered plans, with 79 percent of employers offering these plans in 2011." (Aon Hewitt)

[Opinion] Solutions for CalPERS Health Insurance Rate Hikes"The California Public Employees' Retirement System recently raised health insurance premiums for nearly 1.3 million workers and retirees an average of 9.6 percent for 2013, more than three times the rate of general inflation over the past year. The rate hikes include 8.7 percent increases for basic health maintenance organization coverage and 13.9 percent increases for basic preferred provider organization (PPO) plans.... CalPERS says it has introduced a number of initiatives in recent years to help stabilize rates, but none of these initiatives has included the one strategy proven to 'bend the cost curve' down -- consumer-driven health plans." (Orange County Register)

Patient Choice an Increasingly Important Factor in the Age of the 'Health Care Consumer'"Among the 84% of Americans who visited a doctor's office within the past year, nearly half (47%) reported being very satisfied with their last medical visit; an additional 36% described themselves as somewhat satisfied. Medical visit satisfaction appears to rise with both age and education: very satisfied ratings range from 35% among Echo Boomers (ages 18-35) to 56% among Matures (ages 67+), and from 44% among those with a high school education or less to 52% among those with post graduate education." (Harris Interactive)

Satisfaction Levels Up for CDHPs, Down for Traditional Plans"Satisfaction levels are rising among Americans enrolled in consumer-driven health plans (CDHPs), while they are declining among those in traditional health plans, according to a new report by the nonprofit Employee Benefit Research Institute (EBRI). In particular, satisfaction rates for out-of-pocket costs appear to be trending downward among those with traditional coverage and upward for those with consumer-driven plans, according to the report." (Society for Human Resource Management)

Essential Tactics for CO-OP Prosperity (PDF)"Even before the first member is enrolled, consumer operated and oriented plans (CO-OPs) will invest thousands of hours in developing the operational infrastructure that will provide healthcare coverage for their members. Conventional approaches to managing cost such as contract negotiations with network providers for competitive unit costs and implementing medical management models to curb excessive utilization are important starting points for controlling the cost of claims. However, recent changes to the nation's healthcare system have created a few additional items for CO-OPs to consider as they prepare for October 2013 and enrolling their first members." (Healthcare Town Hall)

Satisfaction With Health Coverage and Care"Satisfaction levels have been trending up among [Consumer Directed Health Plan (CDHP)] enrollees, and trending down among traditional-plan enrollees.... Individuals in [CDHPs] and high-deductible health plans were less likely than those in traditional plans both to recommend their health plan or to stay with their current plan, if they had the opportunity to switch. Dissatisfaction with out-of-pocket costs may be driving overall satisfaction trends." (EBRI)

How Do Consumer-Directed Health Care Plans Affect Medical Care? (PDF)"From 2006 to 2011, researchers ... conducted the first-ever large-scale, multiemployer study of the effect of consumer-directed health care plans on medical care.... The study assessed: The effects of such plans on their users' access to, cost and utilization of health care The plans' particular impact -- if any -- on vulnerable populations (defined for the study as lower-income and chronically ill people) Future national impact of widespread use of such plans." (Robert Wood Johnson Foundation)

How Do Consumer-Directed Health Care Plans Affect Medical Care?"Key Findings: Families enrolling in consumer-directed health plans for the first time in 2005 spent 14 percent less than similar families enrolled in conventional plans. The benefit designs of consumer-directed health plans almost always affected vulnerable populations to the same extent as nonvulnerable populations. If the percentage of the nonelderly population who are enrolled through their employer in a consumer-directed health plan were to increase immediately from 12.4 percent to 50 percent, the savings in personal health care expenditures nationally -- over a 10 year period -- would total $57.1 billion." (Robert Wood Johnson Foundation)

Provider Networks, Premiums Key Factors in Health Plan Choice (PDF)"When given a choice, most individuals with traditional health coverage say they chose that option because it offered a good network of providers ... In contrast, among those with so-called consumer-driven health plans, most cited the lower premiums and opportunity to save money in a health account. While close to half of all private-sector workers who have health insurance are offered a choice of health plans, most of those with a choice work for large firms[.]" (EBRI)

Association Between Personal Health Record Enrollment and Patient Loyalty"Among American healthcare consumers, considerable interest exists in integrated personal health records (PHRs). Across several consumer-focused surveys, 76% to 86% of respondents expressed interest in having Internet access to their health information, yet far fewer -- 7% -- had experience doing so. In a national survey, the majority of respondents reported the belief that online access to health information would have personal benefits that would improve the quality of healthcare. People pay more attention to and become more engaged in their health and medical care when they have easy online access to their health information" (American Journal of Managed Care)

[Opinion] Consumer-Directed Health Plans: Reducing Costs and Maintaining Quality"Over the past decade, the use of consumer-directed health plans (CDHPs) has increased substantially. In 2006, Indiana introduced plans with health savings accounts as a coverage option for state employees. A case study ... examined the outcome of Indiana's implementation and found generous cost savings and increasing annual enrollment. Another study ... found that greater use of CDHPs that use HSAs or HRAs could result in annual savings as high as $57 billion in the overall health care system." (The Heritage Foundation)

The Medical Home Bends the Cost Curve (PDF)"While the Affordable Care Act is trying to manage health insurance, as well as mandating coverage, a number of projects around the country are trying to manage the underlying cost of health care. By bringing back the concept of a true primary care physician, who provides 90% of your care and coordinates with your specialists, these programs are bending the curve of health care cost trends. Most are seeing a reduction in emergency room visits and hospital days in the double digits." (International Society of Certified Employee Benefit Specialists)

Deloitte's 2012 U.S. Survey of Health Care ConsumersClick on the Download button on the linked web page. "Since 2008, the Deloitte Center for Health Solutions has annually polled up to 4,000 U.S. adult consumers about their interest in and ability to operate in a consumer health care market. These surveys queried adults in various age, health status, income, and insurance cohorts to gauge the degree to which consumers are prepared to engage with the health care system as 'patients' or 'consumers.' The distinctions between the two are stark; the implications are transformative -- not only to the health care industry, but to every U.S. household, company, and government agency." (Deloitte Center for Health Solutions)

Consumer-Driven Health Care Plans Can Help Consumers Reduce Health Care Spending"Key results from the study indicate that, following migration from a traditional non-CDHP [Consumer-Driven Health Care Plan] to a CDHP, on average, the CDHP members studied ... reduced health care utilization by an aggregate of more than 12 percent ... spent 24 percent less on inpatient hospital services and eight percent less on outpatient services ... [and] reduced combined medical and pharmacy spend by an aggregate of 11 percent. In addition, data showed that employers who offered only a CDHP saw even greater spend reductions -- up to an aggregate of 14.4% over the three years following migration from a traditional plan to a CDHP." (Health Care Service corporation)

U.S. Healthcare Costs Expected to Rise 7.5% in 2013"The projected growth rate of 7.5% for overall healthcare costs contrasts with expectations for growth of 2.4% in U.S. gross domestic product and a 2.0% rise in consumer prices during 2013 ... Healthcare costs have long been known to outstrip economic growth and inflation rates ... But PwC's Health Research Institute ... said data for the past three years suggest an extended slowdown in healthcare inflation from earlier decades when annual costs rose by double-digits." (Reuters via FoxBusiness.com)

Enrollment in Consumer-Directed Health Plans Grew by 18 Percent in 2011"Thirteen percent of all employees with employer-sponsored plans chose CDHPs [Consumer-Directed Health Plans] in 2011 -- showing an enrollment growth that no other type of insurance plan saw that year. This trend corresponds with a slight, but steady decline in HMOs over that same period. Last year's increase continues a steady growth trend that started in 2008 (7 percent) and continued through 2010 (11 percent). Survey results show that the trend is likely to continue in the near future as well, with 48 percent of employers of all sizes expecting to offer a CDHP in the next 5 years." (American Association of Preferred Provider Organizations (AAPPO))

Consumer-Directed Health Plans Shown to Be Money-Savers"A large study of the medical spending patterns of consumer-directed health plan enrollees, published in the May Health Affairs, found that CDHP enrollees did indeed spend less on care, saving them and their employers money. But the declines were not restricted to unnecessary and redundant tests. The drop also was due to fewer preventive tests and screenings." (American Medical Association)

[Guidance Overview] Whether or Not Constitutional, ACA Is Creating Turbulent Times for HSAs and HRAs (PDF)At page 4. "Health savings accounts (HSAs) avoid many of the regulatory requirements under the ACA because they are not generally considered to be health plan coverage. By way of direct regulation, the ACA did increase the penalty for using HSA funds for non-medical purposes to a 20 percent excise tax (plus applicable income taxes) and requires a prescription for OTC drugs. More dramatically, however, is the potential for collateral damage to HSA viability as a result of ACA's regulation of the underlying high deductible health plan (HDHP) coverage, especially in the fully insured market. Some of this concern has been allayed recently when the agencies indicated that a portion of an employer's contribution (but not salary reductions) to an HSA could count toward the actuarial valuation requirements for the underlying HDHP plans." (Employers Council on Flexible Compensation)

[Guidance Overview] IRS Announcement of 2013 HSA Contribution Limits and HDHP Minimum Deductibles and Out-of-Pocket Maximums"Although all of the inflation-adjusted amounts will increase for 2013, the increases within each category (i.e., self-only or family) are not identical. This has some practical consequences. For example, some individuals may have to pay more out-of-pocket expenses in 2013 without the benefit of the HSA tax break, because the increase in the HSA contribution limit is not keeping pace with the increase in the out-of-pocket maximum. In addition, the greater difference in 2013 between the minimum required deductibles and the out-of-pocket maximums ($5,000 for self-only coverage and $10,000 for family coverage) will allow plan sponsors a wider range of potential deductibles because, at least before 2014, HDHP deductibles can be set as high as the out-of-pocket maximum for that coverage." (Thomson Reuters/EBIA)

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